jNo absolute pre-requisite but familiarity with the material taught in introductory and intermediate-level epidemiology courses is useful as the lectures move rapidly from basic to more advanced material.

Description:

This is a methodology course, which focuses on the historical evolution of methods (e.g., study designs) and concepts (e.g., confounding, bias, interaction and causal inference) that constitute today's epidemiology. For each topic, we review and discuss the historical contexts and some landmark studies that led to specific innovations in terms of performance of group comparisons, population thinking and framing of hypotheses. We finally discuss the historical conditions for the emergence of epidemiology as a scientific discipline, the phases it went through and its potential, future developments. 25 hrs.

"The
approach we used was original. Epidemiologists will like reading
about our work!" These are the statements Alfredo Morabia, Geneva-based
epidemiologist and co-organizer of the first workshop of the History
of Epidemiology held in Annecy, France in early July. Confirming
and even going beyond Dr. Morabia's excitement are the sentiments
of University of Hawaii epidemiologist/historian David Morens, who
calls the workshop "by far the most exciting experience of my professional
career since the EIS. It was not your typical workshop, but a small
collection of knowledgeable senior and junior epidemiologists clustered
together in an intimate setting for 10 days. It was more like being
part of a think tank in a very unusual environmental with long leisurely
meals. As much happened then as at the conference tables!"

Attended
by 20 faculty and 10 students, the participants focused on the history
of epidemiologic methods, including tracing the history of the concepts
of confounding and bias. "We achieved quite a synthesis of information,"
according to Morabia, "and we identified so many fields where more
historical research needs to be done. For example, the history of
screening does not seem to have been investigated", he added.

Among
the topics covered at this workshop were:

the history
of the concept of infection;

early Victorian
epidemiology;

colonial
medicine and epidemiology;

public health
and epidemiology-19th century;

history of
case-control studies;

history of
confounding and interaction;

history of
bias in observational medicine;

history of
cohort studies; and assessment of causality in occupation health

New
discoveries

Part
of the reason for the excitement among the participants was the
feeling that "we were doing something for the first time," says
Morens, describing the work of the group. "We attempted to put on
the table the 'tidbits' of epidemiologic history that many of us
know. We had the feeling we were creating the basic body of knowledge
that is to become the history of epidemiology," says Morens. According
to Morabia, participants did not discover new things about history
as much as they identified elements that appeared to be more important
than previously thought.

For
example, many epidemiologists believe the period between 1880-1940
was not particularly noteworthy for its accomplishments and that
epidemiologists during this time were overshadowed by bacteriologists
making important new discoveries about the etiology of disease.
In fact, the period was a very productive one; the methods for outbreak
investigations and the mode of transmission of many diseases were
established, and the limits of bacteriology in explaining disease
outbreaks were first noted, Morabia explains.

Not
just a hobby anymore

This
workshop reflects a "big change" in the study of the history of
epidemiology, he continues. Heretofore, the study of epidemiology's
history has been mostly a "hobby," Morabia says, and from now on
professional historians will get involved. "It will take years but
we will know the history of the field and not be left as we are
now with mostly anecdotes," he says.

The
workshop was organized as part of a series of sessions on the history
of medicine sponsored each year by the Wellcome Institute and the
Mérieux Foundation. Epidemiologists such as Morabia were
contacted to help organize this session on epidemiology because
"historians see epidemiology as one of the main disciplines in medicine
and one which has used the most original approaches to thinking
about disease and causation," according to Morabia. In attendance
was Mirko Grmek, probably the world's leading medical historian,
according to Morens.

The
workshop 's success is being attributed in part to the variety of
backgrounds among the faculty. Some were professional historians,
such as William Bynum of the Wellcome Institute; others were epidemiologists
who have made history in epidemiology such as Richard Doll, Ernst
Wnder and Milton Terris, and finally others were epidemiologists
interested in history such as Morens who has written on the subject.

A
400-500 page book is expected to be issued by Alfredo
Morabia and his colleague Bernardino Fantini from the Louis
Jeantet Institute for the History of Medicine also located in Geneva.